Sweet Success

Greenville Health System is helping people effectively manage diabetes—and helping others from developing the serious disorder.

Johnny Payne, a participant in GHS’ Diabetes Prevention Program, has adopted a healthy lifestyle—and lost 50 pounds.

The Centers for Disease Control and Prevention (CDC) estimates that over 12 percent of adults in the U.S. have diabetes, which causes blood sugar levels to rise abnormally, potentially leading to heart disease, stroke, kidney failure, blindness and amputations.

Prediabetes (when blood sugar levels are elevated but not enough for a diabetes diagnosis) is critical to understand, according to Michelle Stancil, manager of Diabetes Management for Greenville Health System (GHS). More than one in three adults have prediabetes, but only 10 percent know it. That knowledge gap is devastating, as “prediabetes increases your risk of heart disease, stroke and developing diabetes,” Stancil explained. This progression can cause an array of complications—even death.

Some prediabetes risk factors—such as race, age, sex and family history—can’t be changed. Others, like weight, nutrition choices and physical activity levels, “can be improved with education, effort and support,” observed Celia Witt Beauchamp, a GHS registered dietitian and certified diabetes educator. “That’s where we can sidestep diabetes and all that comes along with it. That’s how we win this battle: prevention.”

Diabetes Prevention Program: Starting from Within

GHS began a CDC-recognized Diabetes Prevention Program (DPP) last year to combat diabetes “early on, and from the inside out,” said Peter Tilkemeier, MD, chairman of GHS’ Department of Internal Medicine. The lifestyle-change program focuses on patients with prediabetes, and its first group drew from GHS employees and their adult dependents. Dr. Tilkemeier continued, “DPP identifies those at a high risk of developing diabetes, provides an opportunity to learn and make changes together, then takes that knowledge into our community.”

“Elevated blood sugar affects every organ and blood vessel from head to toe; it does damage everywhere your blood goes,” pointed out Beauchamp. “Managing those numbers is vital. Rather than waiting until a patient has diabetes to become aggressive, we are addressing what’s smoldering underneath and tackling those factors early on.”

Last November, the first DPP participants began their one-year, 22-session course focused on making lifestyle changes, receiving diabetes prevention training and improving health behaviors. The goal was to prevent participants from developing diabetes by increasing their activity levels and reducing their body weight by five percent to seven percent, a change shown to positively impact blood sugar in many people with prediabetes.

Johnny Payne, an outreach representative for GHS, joined this group to help avoid “moving from prediabetes to a diabetes diagnosis.” He used the program’s blend of education, support and accountability to kick-start a 50-pound weight loss and lifestyle overhaul that brought his blood sugar into normal range.

“I tried on my own to eat better, exercise more and get my blood sugar down,” Payne recalled. “But I was missing something. Now I know more about reading nutrition labels, building muscle to burn calories and eating what I love in smaller portions. Every week, I bring my food and activity logs to our DPP meetings, where people encourage me. That’s made all the difference.”

GHS Chief Science Officer Windsor Sherrill, PhD, echoed these sentiments. “We plan to bring DPP participants together in six months for a meal and a reunion, underscoring the idea that this isn’t just a short-term behavior modification program. We hope they sustain these changes throughout their lives.”

Reaching Community Members Where They Are

The inaugural class saw evidence of success for both the program and its members, according to Stancil, and other groups have begun. Hopes are high that the program’s evidence-based curriculum, along with participant camaraderie and support from certified lifestyle coaches, can help reduce diabetes across the Upstate.

Dr. Sherrill said that the same community-based health promotion strategy is at the heart of an ongoing collaboration between GHS and Clemson University. In late 2017, GHS, Clemson Cooperative Extension and the university’s public health department received a $2.25 million Greenville Health Authority grant supporting two complementary efforts: DPP and a Health Extension for Diabetics (HED) program.

These programs are two sides of the same coin, Dr. Sherrill explained. DPP, created from a research-based lifestyle change program recognized by the CDC, focuses on helping people with prediabetes avoid diabetes, while the HED program helps patients with a diabetes diagnosis manage their condition effectively. Both are led by trained lifestyle coaches.

The HED program, currently limited to Greenville County residents, hit the ground running. “Our participants have seen decreased hemoglobin A1c, which is a test result indicating average blood sugar levels, and increased weight loss. We expect growth in each program—100 to 200 patients per year coming through—and are designing a robust evaluation model to improve outcomes even further,” Dr. Sherrill described.

There is every reason to believe these diabetes prevention and management programs can chip away at the growing epidemic our state faces, she added. “Through these efforts, we anticipate seeing decreased illness and decreased healthcare utilization. These programs have the potential to be replicated, and we hope to expand statewide.”

This fresh approach to diabetes prevention—taking education out of physicians’ offices andinto community centers—sets GHS apart.

“One of the reasons I came to GHS is our focus on community health and wellness,” noted Dr. Tilkemeier. “We aim to set a standard and improve health care in South Carolina by evaluating how we deliver care to our community. Our partnership with Clemson targets populations who may avoid or otherwise not regularly see physicians. The program’s extension offices are safe spots filled with trusted community members; GHS is keeping people out of hospitals by reaching them right where they are.”